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Biomedical subjects

B Kröner-Herwig

Publications and source records attributed to B Kröner-Herwig.

18 recordsLinked to original sources
PubMed2006

Psychological treatment of recurrent headache in children and adolescents--a meta-analysis.

Psychologically based interventions such as relaxation training, biofeedback and cognitive-behavioural therapy are increasingly discussed as options for the treatment of migraine and tension-type headache in children and adolescents. In order to determine the state of evidence regarding the efficacy of these treatments, a meta-analysis of randomized controlled studies was conducted. In a comprehensive literature search including data from 1966 to 2004, 23 studies were found meeting the inclusion criteria. Due to the application of the random effects model, generalization of the results is possible. Specific statistical procedures were used to account for a possible publication bias. Significantly more patients improved to a clinically relevant extent (headache reduction > or =50%) in treatment conditions compared with waiting list conditions (high effect sizes). Long-term stability was also confirmed. The analysed treatments lead to improvement (up to 1 year) in headache status in children and adolescents with primary headache. However, more well-designed studies are needed to support and consolidate the conclusions of this meta-analysis and to compare the effects of psychological treatment with those of prophylactic medical interventions (in migraine), to examine potential differences between treatments, to identify moderators of efficacy and to determine effects of treatment on other health-related variables such as quality of life.

Adolescent↗
PubMed2003

The management of chronic tinnitus: comparison of an outpatient cognitive-behavioral group training to minimal-contact interventions.

OBJECTIVE: Using a randomized group design, the efficacy of an outpatient cognitive-behavioral Tinnitus Coping Training (TCT) was compared to two minimal-contact (MC) interventions. METHODS: TCT was conducted in a group format with 11 sessions (total n=43). One MC [MC-E (education), n=16] consisted of two group sessions in which education on tinnitus was presented and self-help strategies were introduced. The second MC [MC-R (relaxation), n=16] comprised four sessions. Besides education, music-supported relaxation was suggested as self-help strategy and audiotapes with relaxing music were provided. Furthermore, a waiting-list control group was installed (WC, n=20). Data were assessed at baseline (pretherapy) and at posttherapy period. Only TCT was additionally evaluated at a 6-month and a 12-month follow-up. Several outcome variables (e.g., awareness of tinnitus) were recorded in a tinnitus diary. Tinnitus coping and disability due to tinnitus were assessed by questionnaires. Subjective ratings of improvement were also requested from the patients. Furthermore, inventories of psychopathology were given to the patients. RESULTS: Findings reveal highly significant improvements in TCT in comparison to the control group (WC). MC interventions do not differ significantly from each other, but are superior to WC in a few domains of outcome. Outcome in TCT is somewhat superior to combined MC interventions in two domains of data, but not regarding disability reduction. Effect sizes, nevertheless, indicate distinct differences in degree of improvement, with TCT achieving the best results. CONCLUSIONS: A sequential scheme for the treatment of chronic tinnitus is discussed on the basis of cost-effectiveness considerations.

Adaptation, Psychological↗
PubMed2001

Fear-avoidance behavior and anticipation of pain in patients with chronic low back pain: a randomized controlled study.

OBJECTIVE AND DESIGN: In a randomized controlled study, we investigated whether pain anticipation and fear-avoidance beliefs will lead to behavioral avoidance. PATIENTS: Fifty patients with chronic low back pain (CLBP) performed a simple leg-flexion task. Before the test, members of a control group were informed that the movement would not result in any increase of pain, whereas experimental group participants were told that a slight increase of pain could occur. OUTCOME MEASURES: All patients completed the Fear-Avoidance-Beliefs Questionnaire (FABQ) and the Pain Disability Index (PDI). As dependent variables, different behavioral performance parameters were registered by a computerized protocol: number of flexion movements, mean range of motion, and mean work ratio. Furthermore, patients were asked about their pain intensity as well as their fear (at the moment) and finally were asked to judge the unpleasantness of the experiment (using visual analogue scales for each of the three variables). RESULTS: Inducing pain anticipation (by instruction) led to significantly lower levels of behavioral performance as well as increased pain intensity and fear during the test. Behavioral performance was significantly correlated with fear-avoidance beliefs. CONCLUSIONS: Results confirm that pain anticipation and fear-avoidance beliefs significantly influence the behavior of patients with low back pain in that they motivate avoidance behavior. Therapists must be aware of the powerful effects of cognitive processes, which can give rise to fear of pain and, consequently, avoidance behavior.

Clinical Trial↗
PubMed2000

Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ).

Fearful avoidance of physical activities is a major factor in low back pain (LBP) and disability. In 1993 Waddell et al. developed the Fear-Avoidance Beliefs Questionnaire (FABQ) focusing on patients' beliefs about how physical activity and work affect LBP. The focus of our study was to analyse and validate the German version of the FABQ. Three-hundred and two consecutive LBP outpatients participating on a functional restoration programme filled in the FABQ. Factor analysis yielded three factors which accounted for nearly 65% of the total variance of the questionnaire. Whereas the factor 'physical activity' (8.9% of the variance) remained the same as in the English version, the second factor of the original version split into two: one related to, 'work as cause of pain' (43.4% of the variance) and the other to patients' assumptions of their probable return to work (11.8% of the variance). Both work-related subscales showed a good internal consistency (alpha = 0.89, resp. alpha = 0.94), whereas the consistency of the subscale 3 'physical activity' was only modest (alpha = 0.64). Test-re-test reliability score was fair to good for the whole scale (r = 0.87;n = 30). Regression analysis demonstrated that fear-avoidance beliefs account for the highest proportion of variance (35%) regarding disability in activities of daily living and work loss. Patients out of work demonstrated more fear-avoidance beliefs in comparison to those who were still working. It can be concluded that the German version of the FAQB is a reliable and valid instrument, but it shows a different factor structure from the original English version. The FABQ has been proven to identify patients with maladaptive beliefs which have to be focused on in proper treatment.

Adult↗
PubMed2000

Stress and the onset of sudden hearing loss and tinnitus.

Forty hospitalized patients with sudden hearing loss and tinnitus were compared to a control group (N = 28) of inpatients of an ear-nose-throat ward. They were similar in various background variables except for the kind of disorder itself. The main objective of our study was to test the hypothesis of stress as a predisposing risk factor in the development of sudden hearing loss and tinnitus. Thus, differences in life events and daily "hassles" were expected between groups, as were differences in coping styles, habitual worrying, and social support. The hypothesis of more frequent and more stressful life events and daily hassles was supported empirically. The dominant role of daily hassles, especially their stressfulness as a risk factor, was shown clearly. Those in the experimental group also reported more coping endeavors and more worrying. Social support had no discriminating function. The prospective part of the study aimed at the prediction of chronicity of sudden hearing loss and tinnitus (3 months after onset) by sociodemographic, psychological, and disease-associated variables. The strongest predictor of chronicity was the degree of well-being at the time of first assessment (soon after disease onset). Coping and a fatalistic locus of control also had some predictive power. Methodological limitations of the study are discussed.

Activities of Daily Living↗
PubMed1998

Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement on outcome.

The relative efficacy of EMG-frontalis feedback and progressive relaxation was examined in children with tension-type or combined headaches (8-14 yrs. old). Furthermore, the influence of parent involvement, in the form of a three-session educational approach, on training outcome was systematically explored (2 x 2 factor design). Fifty children took part in the study, 40 were randomly assigned to the four different treatment conditions, 10 children participated in the self-monitoring control group. The training comprised 6 sessions of 1 hr each in the relaxation treatment and 12 sessions of 1/2 hr duration in the biofeedback group. Headache diaries were kept by children and parents for 4-week period prior to therapy, and for a similar length of time at post-treatment and follow-up (6 months). Multivariate analyses of variance on the headache diary data yield no significant main or interaction effects of treatment format or of parent involvement, but only a main effect of period, indicating a general efficacy of the four treatment conditions. At follow-up the reduction of headache activity is even more prominent. A different evaluative approach points to the superiority of biofeedback revealing a mean effect size for biofeedback training that reflects a good to excellent improvement rate. Correlations between headache data from children and parents are high.

Adolescent↗
PubMed1997

[Quality control in the therapy of chronic pain. Results obtained by a task force of the German Section of the International Association for the Study of Pain on psychological assessment of chronic pain. XI. Assessment and multiaxial classification of pain].

This paper reviews instruments in German language for the psychological assessment and classification of pain. Usually chronic pain syndromes are classified within the International Classification of Diseases (ICD). Instead of the psychiatric chapter of the ICD, it is possible to use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The proposed classification system of the International Association of the Study of Pain (IASP) is based on a multiaxial solution. The numerous ways to classify chronic pain include many problems and limits, especially in the case of an interdisciplinary assessment. They provide no specific system for classifying pain syndromes. They are impractical to handle and restrict classifying pain as either somatogenic or psychogenic. It is not possible to describe both sides in one diagnosis without loss of information. As a result of this situation, a task force of the German Chapter of the International Association for the Study of Pain developed a Multiaxial Classification of Pain (Multiaxiale Schmerzklassifikation; MASK) as an advanced system of pain assessment and an alternative to the common classification systems. MASK embraces a somatic (MASK-S) and a psychological (MASK-P) part. Both parts constitute an 'interdisciplinary diagnosis'. MASK-S enables classifying a pain syndrome using hierarchical levels, with progredient specific degrees of differentiation. In addition there are 6 axes to describe pain syndromes qualitatively and quantitatively (e.g. localization, quality). The psychosocial part (MASK-P) embraces 5 main levels (1. behavioral, 2. emotional, 3. cognitive, 4. stress-related, 5. habitual personal factors) and 2 additional levels (6. functional coherence, 7. ICD/DSM-diagnosis additional). The MASK-P part of the diagnosis is composed of graduation on these levels. Differential axis of the pain syndromes are described phenomenologically and specifically. MASK provides the possibility of establishing an integrative, interdisciplinary diagnosis.

English Abstract↗
PubMed1997

[Quality assurance in chronic pain therapy. Results obtained by a task force of the German Chapter of the International Association for the Study of Pain on psychological Assessment of chronic Pain. Psychological instruments for the assessment of pediatric pain].

The present paper is one in a series of publications reviewing German instruments for the psychological assessment of pain. Part X deals with pain measurement of acute and chronic pain in infants and children. German assessment instruments of pediatric pain together with frequently used instruments of American origin are examined and described. The survey contains self-report and behavioral pain measures. Multidimensional pain interviews for both children and parents, diaries and rating scales, as well as observation measures especially for infants, are examined. Since the selection of pain-assessment instruments is dependent on the age and cognitive level of the children, for each instrument a minimum age limit is given. In cases in which quantitative indices of reliability, validity and objectivity are still needed, the evaluation is based on qualitative quotations.

English Abstract↗
PubMed1997

Incorporation of cognitive-behavioral treatment into the medical care of chronic low back patients: a controlled randomized study in German pain treatment centers.

Cognitive behavioral treatment has been incorporated into standard medical treatment procedures in German pain centers. Acceptance of the treatment by patients and outcome in terms of pain, coping, and disability was investigated. Components of the psychological treatment are education, relaxation and imagery, modifying thoughts and feelings, enhancement of pleasant activities, and training of good postural habits. The program was conducted in a group setting in accordance with a treatment manual and consists of 12 weekly 2.5-h sessions. A two-factor experiment with repeated measures on one factor was applied. Ninety-four consecutive patients with low-back pain were randomly assigned to an experimental group having a combined medical and cognitive-behavioral treatment, or to a control group with medical treatment only. Assessments were taken pre-treatment, post-treatment, and--in the treated group only--at a 6-months follow-up. At each assessment, patients kept a pain diary over a period of 4 weeks, and filled in self-report questionnaires. The sample consisted of 36 experimental and 40 control subjects at post-treatment. Experimental subjects reported less pain, better control over pain, more pleasurable activities and feelings, less avoidance and less catastrophizing. In addition, disability was reduced in terms of social roles, physical functions and mental performance. The results were maintained at follow-up. Patients who only received medical treatment showed little improvement. Data indicate that the program meets the needs of the patients and should be continued.

Adult↗
PubMed1996

[Quality assurance in therapy of chronic pain. Results obtained by a task force of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. IX. Multidimensional instruments for the assessment of aspects relating to pain and recommendations on standard procedures for diagnosis].

Four multidimensional inventories used as instruments for the assessment of pain are examined: "Fragebogen zur Erfassung der Schmerzverarbeitung' [Questionnaire for Assessment of Level of Coping with Pain], "Kieler Schmerzverarbeitungs-Inventar' [Kiel Inventory of Coping with Pain], "Fragebogen zur Schmerzregulation' [Questionnaire on Pain Regulation], and the German version of the "Multidimensional Pain Inventory'. None of these questionnaires assesses all domains that are important in chronic pain. The recommended standardized assessment routine for pain centres includes the use of a diary, the rating of actual, average and maximum pain intensity, the application of the PDI, a measure of disability, and the FESV, which records cognitive processing and coping. As measures of general psychological dysfunction the ADS for the assessment of depression and the B-L, a symptom checklist, are suggested as instruments suitable for routine use in diagnosis and evaluation.

English Abstract↗
PubMed1996

Predicting subjective disability in chronic pain patients.

Subjective disability is considered as the variable that reflects the impact of chronic pain on a patient's life. This study examines the questions of which syndrome or patient characteristics determine subjective disability and whether there are differences between samples of patients with chronic headaches and low back pain. Direct pain variables and depression, pain coping strategies, and pain-related self-statements (including catastrophizing) are introduced into multivariate regression analyses as potential predictors of disability using a sample of 151 pain patients. Disability is not predicted by pain severity in patients with headaches or back pain. Psychological variables, especially coping strategies, are far more influential. Coping explains more variance in disability in the headache sample than in the chronic law hack pain group, whereas depression is more relevant for the degree of disability in the back pain sample. In this study, we present a critical analysis of possible interpretations of our results. We point to an overlap of concepts underlying some of the variables used: this overlap also considerably invalidates conclusions drawn from a multitude of studies done in this field, including the one presented. We strongly argue for a conceptual clarification, and consequently for the revision of assessment instruments, before further empirical work in this area is done.

Journal Article↗
PubMed1996

[Psychological stress on patients in tumor after-care after R0 resection of colorectal carcinomas].

In a prospective study 70 patients after curative resection for colorectal carcinoma were asked about the psychological strain in the follow-up program. Of these patients, 80.1% felt that they did the right thing and 70% were optimistic and confident regarding the follow-up examinations. Only 5 patients (7.1%) had no intention of keeping the follow-up appointment and 12 patients (17.1%) were thinking about recurrence. The patients were afraid of further examinations, and the majority (45 patients) hoped that further invasive examinations would not be necessary. Patients with a higher frequency of follow-up examinations did not report with more stress than patients fewer follow-up visits (P = 0.7 fisher exact). Older, single and female patients are special risk groups with a high level of psychological strain and should receive special attention within the follow-up (P < 0.08, fisher exact). In spite of the disappointing medical effectiveness of the regular follow-up program, psychological support in coping with cancer is the main result of regular follow-up visits to the hospital after curative resection of colorectal carcinoma and should be maintained.

Adaptation, Psychological↗
PubMed1995

The management of chronic tinnitus--comparison of a cognitive-behavioural group training with yoga.

Two non-medical treatment strategies for chronic idiopathic tinnitus were evaluated in a randomized control group design. A cognitive-behavioural tinnitus coping training (TCT) was developed and compared to yoga and a self-monitoring control condition. Forty-three chronic tinnitus patients, were assessed at baseline, directly after therapy, and at 3 months follow-up. For evaluation, differential psychoacoustic variables were registered, a tinnitus diary as well as the Tinnitus Questionnaire and different measures of general well-being were used. Statistical analyses showed effects favouring the TCT treatment in comparison to the control and yoga treatment. The TCT-treated patients reported more satisfaction with the training than the yoga group. Participants in the self-monitoring control group were treated either by TCT or yoga after a waiting period. The outcome in this group was even better than in the experimental groups while yoga again showed rather poor effects.

Adaptation, Psychological↗
PubMed1993

The physiological stress response and the role of cognitive coping in migraine patients and non-headache controls.

Our study investigated physiological response specificity and cognitive coping in migrainous patients during an achievement task situation. Thirty-three migrainous subjects and thirty-two non-headache controls were subjected to 40 min of demanding cognitive tasks and 20 min of recovery during which cranial and peripheral vasomotor responses were registered as well as electrodermal and myographic activity. Subjects of both groups were randomly assigned to two experimental conditions, a so-called 'spontaneous processing condition' and the 'positive coping treatment'. In this treatment condition subjects received a short training in the conscious use of positive self-statements in stress situations. Though a specific pattern of cranial vasomotor responses in migraine subjects could be verified by group statistics, this pattern was only found in very few individuals. Reliable differences between groups could not be identified in other physiological variables either. The hypothesis that the predicted cranial vasomotor specificity in migraine subjects correlates with negative cognitive coping habits in migraine subjects best revealed in the 'spontaneous processing' condition, was not corroborated. The treatment variation regarding coping produced somewhat paradoxical effects, more relaxed and positive self-evaluation (subjective level) and more arousal (physiological level). Results are discussed for their impact on the psycho-biological model of migraine.

Adaptation, Psychological↗
PubMed1990

The effect of exercise and induced expectations on visceral perception in asthmatic patients.

It is assumed that visceral perception of the asthmatic patient is not only influenced by the physiological response itself but also by cognitions, i.e. specific illness related attitudes and expectations. Thirty-two adult asthmatics were studied in a 2 X 2-factorial design to examine the effect of physical exercise due to an ergometer capacity test (set at a load of 40 and 80 watt respectively) and induced expectations about the consequences of this task on broncho-constriction. Two sets of instructions were used to induce anticipations of harmful and non-harmful consequences respectively. The following dependent variables were registered: airways resistance, skin resistance and visceral perception (rating of physiological changes). Before the experiment the habitual way of reacting to asthma-relevant cues in each subject was assessed. Only small effects of the different ergometer loads on physiological responding and no effects of the experimental variables on visceral perception were found using an analysis of variance approach. A covariance analysis, however, using the trait variable as covariate, demonstrated that the induced 'harmful' anticipation significantly intensified the perception of visceral changes and even had some influence on asthma-relevant physiological responding.

Adolescent↗
PubMed1988

Psychophysiological reactivity of migraine sufferers in conditions of stress and relaxation.

The assumption of a specific migraine-related psychophysiological response stereotype under conditions of stress, recovery and relaxation was examined in 37 migraineurs (non-headache state) and 44 normal controls. Two stressors were presented, industrial noise and a 'social discomfort' situation, each was followed by a recovery period. Relaxation was induced by verbal instructions accompanied by soft music. The following physiological measures were assessed: pulse volume amplitude (fronto-temporal and digital), skin temperature (fronto-temporal and digital) and skin resistance responses. Results showed no group differences in responses to the stressors. Physiological recovery from stress was delayed in migraineurs in the electrodermal parameter. During relaxation, migraineurs showed less digital vasodilation than the controls. Overall, physiological and subjective responses differed between the two stressors. The hypothesis of a specific vasomotor stress response stereotype in migraineurs could not be corroborated. The observed differences in relaxation and recovery were hypothesized. But the overall results are not easily explained on the grounds of a coherent model (e.g. elevated sympathetic arousal level).

Adult↗